Evaluation of skin and mucosal warts caused by human papillomavirus (HPV) and treatment with appropriate methods (electrocautery, cryotherapy, topical agents).
Indication
- Verruca vulgaris (rough warts on the hands and fingers)
- Verruca plantaris (plantar wart) — warts that cause pain when walking and become embedded due to pressure
- Verruca plana (flat, small warts on the face and back of the hand)
- Genital warts (condyloma acuminatum) — in the anogenital region in women and men
- Filiform warts (thread-like warts on the face, neck, and eyelids)
- Widespread or treatment-resistant warts in immunocompromised patients
Preparation
- The skin must be clean, free of cream and makeup before the procedure
- Patients on blood thinners are evaluated with physician approval
- Any known reactions to local anesthesia or cold allergy must be reported
- For genital lesions, partner examination and gynecology-urology consultation are recommended if needed
- The procedure is postponed if another active skin infection such as herpes is present
How it's performed
- The physician examines the wart with a dermatoscope; HPV subtypes are clinically distinguished (HPV 1-2-4 cutaneous; HPV 6-11 low-risk genital; HPV 16-18 high-risk)
- The method is selected based on location and number: cryotherapy (liquid nitrogen), electrocautery, curettage, laser, or topical acid/imiquimod
- If cauterization is planned, local anesthesia is applied and the wart tissue is controllably burned
- For genital warts, treatment selection is tailored to the mucosa, pregnancy status, and number of lesions
- After the procedure, the area is cleaned with antiseptic and open-wound care instructions are provided
- Complete clearance in a single session is rarely possible; an average of 2-4 sessions may be planned
Post-procedure
- The treatment site is expected to heal by crusting and shedding within 7-14 days
- The first follow-up is usually after 3-4 weeks; additional sessions may be applied to the same or adjacent lesion if needed
- For genital HPV-related lesions, partner evaluation and Pap smear follow-up in female patients are recommended
- Vaccination status is reviewed; HPV vaccine is recommended in the appropriate age range
- Early follow-up for any new lesion, bleeding, or non-healing wound
Risks
- Mild burning, crusting, and transient marks after cauterization
- Permanent color change (hyperpigmentation or hypopigmentation), especially in dark-skinned individuals and sun-exposed areas
- Prominent scarring; rarely keloid formation
- Recurrence of the wart despite treatment (residual or new HPV infection)
- Risk of transient pain, discharge, or bacterial infection after treatment in genital areas
FAQ
Are warts contagious?
Yes. Warts are transmitted by HPV; transmission can occur via shared towels, razors, shoes, bathroom floors, and sexual contact. Transmission is easier when the skin has small cuts or cracks.
Do warts go away on their own?
Some warts, especially in children, may regress spontaneously within 1-2 years. However, treatment is necessary for spreading, painful, recurrent, or genital lesions.
Is cauterization painful?
After local anesthesia, the procedure itself is generally painless. Mild burning and tenderness during healing may last for a few days.
Does the HPV vaccine treat warts?
The HPV vaccine does not treat existing warts; however, it is an important preventive method to reduce transmission of new HPV subtypes and serious future outcomes such as cervical cancer.
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